| NPI | 1932662749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 68337) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 30255) |
| Enumeration Date | 2019-04-09 |
| Last Update Date | 2025-06-19 |